<table width="100%" align="center" border="0" cellspacing="1" cellpadding="1" bgcolor="#000000">
<tr><td>
<table width="100%" align="center" border="0" cellspacing="1" cellpadding="1" bgcolor="#ffffff">
<tr><td>
<table width="100%"align="center" border="0" cellspacing="1" cellpadding="1">
  <tr>
	<td></td>
  </tr>
  <tr>
	<td>
	<form method="post" action="proses1.php">
	<table width="63%">
      <tr>
        <td width="20" height="24"><input type="checkbox" name="nimCat" /></td>
        <td width="122">Pasien</td>
        <td width="226"><input type="text" name="nim" /></td>
      </tr>
      <tr>
        <td height="24"><input type="checkbox" name="namaCat" /></td>
        <td>Petugas</td>
        <td><input type="text" name="nama" /></td>
      </tr>
      <tr>
        <td height="24"><input type="checkbox" name="alamatCat" /></td>
        <td>Poli</td>
        <td><input type="text" name="alamat" /></td>
      </tr>
      <tr>
        <td>&nbsp;</td>
        <td>&nbsp;</td>
        <td>&nbsp;</td>
      </tr>
      <tr>
        <td></td>
        <td></td>
        <td><input type="submit" name="submit" value="Search" /></td>
      </tr>
    </table>
	</form></td>
  </tr>
</table></td></tr>
</table>
</td></tr>
</table>
